Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure

The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 ± 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 ± 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngeosophageal spasm, a factor limiting voice rehabilitation.

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Voice Rehabilitation After Total Laryngectomy and Postoperative Radiation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2002.07.047 ◽

2002 ◽

Vol 20 (10) ◽

pp. 2500-2505 ◽

Cited By ~ 40

Author(s):

William M. Mendenhall ◽

Christopher G. Morris ◽

Scott P. Stringer ◽

Robert J. Amdur ◽

Russell W. Hinerman ◽

...

Keyword(s):

Radiation Therapy ◽

Total Laryngectomy ◽

Voice Rehabilitation ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Artificial Larynx ◽

Postoperative Irradiation ◽

Tracheoesophageal Puncture

PURPOSE: The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx. PATIENTS AND METHODS: Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation. RESULTS: Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively. CONCLUSION: The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.

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Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long-Term Results with Indwelling Voice Prosthesis

Otolaryngology ◽

10.1016/j.otohns.2005.02.014 ◽

2005 ◽

Vol 133 (1) ◽

pp. 89-93 ◽

Cited By ~ 50

Author(s):

Carlos T. Chone ◽

Flávio M. Gripp ◽

Ana L. Spina ◽

Agricio N. Crespo

Keyword(s):

Success Rate ◽

Total Laryngectomy ◽

Voice Prosthesis ◽

Long Term Results ◽

Voice Rehabilitation ◽

Patient Age ◽

Patient Âgé ◽

Tracheoesophageal Puncture

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% ( P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary ( P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

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Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003861 ◽

2008 ◽

Vol 123 (4) ◽

pp. 426-433 ◽

Cited By ~ 4

Author(s):

O A Albirmawy ◽

A S El-Guindy ◽

M N Elsheikh ◽

M E Saafan ◽

M E Darwish

Keyword(s):

Total Laryngectomy ◽

Speaking Rate ◽

Voice Rehabilitation ◽

Muscle Repair ◽

Mean Values ◽

Voice Restoration ◽

Pharyngeal Plexus ◽

Significant Difference ◽

Tracheoesophageal Puncture ◽

Repair Group

AbstractObjectives:The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy.Study design:Prospective, clinical study.Setting:Otolaryngology department, Tanta University, Egypt.Methods:Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters.Results:Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group.Conclusion:The four hypopharyngeal repair types – primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair – were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

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The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment

The Journal of Laryngology & Otology ◽

10.1017/s0022215100139337 ◽

1997 ◽

Vol 111 (11) ◽

pp. 1060-1063 ◽

Cited By ~ 10

Author(s):

Ching-Ping Wang ◽

Tzu-Chan Tseng ◽

Rheun-Chuan Lee ◽

Shyue-Yih Chang

Keyword(s):

Total Laryngectomy ◽

Fistula Formation ◽

Voice Rehabilitation ◽

Pharyngocutaneous Fistula ◽

Swallowing Function ◽

Pharyngeal Muscle ◽

Constrictor Muscle ◽

Pharyngoesophageal Segment ◽

Pharyngeal Muscles ◽

Closure Group

AbstractThe usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.

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Long-Term Follow-up of Tracheoesophageal Puncture Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500701 ◽

1996 ◽

Vol 105 (7) ◽

pp. 501-503 ◽

Cited By ~ 21

Author(s):

James A. Geraghty ◽

Bonnie E. Smith ◽

Barry L. Wenig ◽

Louis G. Portugal

Keyword(s):

Low Socioeconomic Status ◽

Total Laryngectomy ◽

Success Rates ◽

Vocal Rehabilitation ◽

Speech Rehabilitation ◽

Long Term Follow Up ◽

Tracheoesophageal Speech ◽

Tracheoesophageal Puncture

Since its introduction by Blom and Singer in 1980, tracheoesophageal puncture with a voice prosthesis has become the most frequently recommended choice for speech rehabilitation of total laryngectomees. Many studies have reviewed the initial speech acquisition success rates following tracheoesophageal puncture; however, long-term follow-up in these initial successes has been lacking. In addition, factors predictive of long-term success with tracheoesophageal speech have not been defined. Over a 10-yearperiod, we retrospectively reviewed all total laryngectomy patients, including those who have undergone primary or secondary tracheoesophageal puncture, at the University of Illinois Hospital and Clinics and the Westside Veterans Administration Hospitals. Survival in the total laryngectomy cohort of 202 patients ranged from 35% to 50%. Forty of these patients underwent tracheoesophageal puncture, in whom survival was 75%. Short-term success with tracheoesophageal speech was approximately 70% for our patients, while long-term success was achieved in 66%. Despite low socioeconomic status and relatively high alcoholism rates, successful maintenance of tracheoesophageal speech was achieved in the majority of cases. Tracheoesophageal speech should therefore be considered as a primary method of vocal rehabilitation in all patients undergoing total laryngectomy.

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Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1034 ◽

2012 ◽

Vol 2 (1) ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

Sudhir M Naik

Keyword(s):

Case Report ◽

Total Laryngectomy ◽

Voice Prosthesis ◽

Voice Rehabilitation ◽

Wide Field ◽

Wide Angle ◽

Puncture Site ◽

History Of ◽

Tracheoesophageal Puncture ◽

The Voice

ABSTRACT Background/objectives Prosthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate. Conclusion Tracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Naik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

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Managing problems with tracheoesophageal puncture for alaryngeal voice rehabilitation

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000752 ◽

2006 ◽

Vol 120 (6) ◽

pp. 470-477 ◽

Cited By ~ 7

Author(s):

O A Albirmawy ◽

M N Elsheikh ◽

M E Saafan ◽

E Elsheikh

Keyword(s):

Adverse Events ◽

Success Rate ◽

Medical Records ◽

Multidisciplinary Approach ◽

Clinical Analysis ◽

Voice Rehabilitation ◽

Voice Restoration ◽

Early Results ◽

Tracheoesophageal Puncture

Objectives: The tracheoesophageal puncture (TEP) technique and the insertion of its associated voice prostheses may give rise to adverse events. We present our experience with this technique, paying special attention to the incidence and management of these adverse events.Study design: A retrospective clinical analysis was undertaken.Methods: Seventy-five laryngectomized patients underwent TEP for voice restoration. They were divided into two groups: group one, 43 patients with secondary TEP; and group two, 32 patients with primary TEP. Patient medical records were reviewed for data on the incidence, management and outcome of adverse events encountered during patients' follow up.Results: Problems that arose in the patients were itemized as either early or late. The same patient could develop one or more problems in either group. The management of these problems, concerning the creation and maintenance of the TEP and associated prostheses, was noted. In group one, results were initially favourable in 91 per cent of patients and still positive in 81.4 per cent after three years. In group two, early results were favourable in all patients, and only two patients asked for late elective closure of the TEP (with a success rate of 93.7 per cent).Conclusions: Via an intensive and multidisciplinary approach to problems, most of the inevitable adverse events could be solved adequately, minimizing the discomfort of patients who had undergone laryngectomy and indwelling voice prosthesis insertion.

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Outcome of Total Laryngectomy in Regional Hospitals of Bangladesh

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i2.56360 ◽

2021 ◽

Vol 27 (2) ◽

pp. 139-144

Author(s):

M Saiful Islam ◽

Md Shahjahan Kabir ◽

Md Abdullah Al Harun ◽

Md Abdur Razzak ◽

Mohosana Khanam ◽

...

Keyword(s):

Laryngeal Cancer ◽

Total Laryngectomy ◽

Prospective Observational Study ◽

Tertiary Care ◽

Voice Rehabilitation ◽

Primary Case ◽

Medical College ◽

Regional Hospitals ◽

Stomal Stenosis

Objectives: To analyze post operative complications, local recurrence, functional outcome of speech & swallowing and survival rate following total laryngectomy. Methods: This prospective observational study was done in four major tertiary care medical college hospitals of Bangladesh from July 2000 to December 2019. All operations were done by a single surgeon, one of the authors of this study based on the personal experience. 45 patients were selected who underwent total laryngectomy for biopsy proven advanced (T3 and T4) laryngeal cancer as primary case & recurrent cases following radiotherapy. Patients were followed up monthly for three months and then six monthly for two years and yearly for rest of their life. Results: Age of the patients ranged from 42 to 80 years with mean age 56.7 years. In postoperative period 03 (6.6%) patients developed wound infection, 03 (6.6%) stomal stenosis, 03 (6.6%) stomal recurrence, 02 (4.4%) seroma, 02 (4.4%) pharyngo-cutaneous fistula and 01 (2.2%) case developed pharyngeal stenosis. In post laryngectomy voice rehabilitation 33 (73.3%) cases used esophageal voice, 07 (15.5%) cases used electrolarynx and 05 (11.1%) cases used bloom singer valve. Out of oesophageal speech, 2 patients had poor speech, Regarding swallowing all patients had very good swallowing except one patient who got pharyngeal stenosis, needed dilation. 3 patients died in subsequent 2 years follow-up and overall survival was 93.3%. Conclusion: Outcome of total laryngectomy depends on site and size of tumour, nodal metastases, recurrent cases and co-existing co-morbidities. Total laryngectomy with or without radiotherapy offers significantly higher local control and survival benefit with advanced laryngeal cancer, compared to radiotherapy only. Bangladesh J Otorhinolaryngol 2021; 27(2): 139-144

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Use of Ultrasound for Sizing Tracheoesophageal Puncture Prostheses

Otolaryngology ◽

10.1177/0194599817722947 ◽

2017 ◽

Vol 157 (6) ◽

pp. 1075-1078

Author(s):

Aaron Smith ◽

Vikrum Thimmappa ◽

Julia Jones ◽

Courtney Shires ◽

Merry Sebelik

Keyword(s):

Wall Thickness ◽

Gold Standard ◽

Total Laryngectomy ◽

Primary Closure ◽

Ultrasound Measurement ◽

Voice Rehabilitation ◽

Flap Reconstruction ◽

Tracheoesophageal Puncture ◽

Party Wall ◽

Posterior Tracheal Wall

Tracheoesophageal puncture (TEP) with voice prosthesis placement is the gold standard voice rehabilitation following total laryngectomy. Ultrasound may be useful to determine tracheoesophageal wall thickness, guiding prosthesis choice. Therefore, 14 patients undergoing total laryngectomy and TEP or prosthesis change with 16-mHz ultrasound measurement of the posterior tracheal wall were included. Seven patients underwent secondary TEP, 3 primary TEP, and 4 TEP changes. Six patients underwent flap reconstruction, while 8 patients were closed primarily. Average party wall thickness was 9.6 ± 1.7 mm, without a difference ( P = .08) between primary closure (10.3 ± 1.7 mm) and flap reconstruction (8.6 ± 1.4 mm). Change from the hypothesized sizing was noted in 11 patients (79%). Prosthesis size did not correlate with age (–0.19, P = .51), height (–0.12, P = .69), weight (0.26, P = .38), body mass index (0.22, P = .46), or flap status (–0.48, P = .079). These data suggest that ultrasound is beneficial in patients with distorted or less predictable anatomy (eg, flap reconstruction) but also important for those patients undergoing primary closure.

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